Individual and social factors associated with antiretroviral treatment adherence among HIV positive adolescents attending care and treatment clinics in Dodoma Municipality

Abstract

Background: Treatment adherence is generally regarded as an important factor in achieving optimal outcomes across many disease states. Unfortunately, most HIV-infected adolescents find it extremely difficult to adhere to their dosing schedules consistently. ALHIV often face multiple barriers to adherence including structural barriers in fitting medication into complex patterns of daily life, low expectancy for outcome of antiretroviral therapy and mental health/substance abuse. The increased access to antiretroviral treatment (ARV), has resulted to children who have survived the diversity of the disease and are now adolescents or young adults. This cause the number of HIV positive adolescents to grow with high incidence rates. Adolescents are vulnerable to HIV due to the physical and emotional transitions, and potentially heightened risk-taking behaviour, inherent to this period of life. Following the UNAIDS post 2015 ambitious plan of averting HIV and AIDS in the globe, 90% of all diagnosed HIV positive clients should be initiated into life serving treatment, should be retained into care and be virally suppressed by the year 2020. To achieve this, all people initiated in ARV should remain in care and maintain good treatment adherence on ARV medication. Objective: To assess the level of adherence and identify the individual and social factors associated with antiretroviral treatment adherence among HIV positive adolescents in care and treatment clinics in Dodoma Municipality. Methodology: This was a cross-sectional study employing qualitative approach to data collection and analysis. The study population were seventeen HIV positive adolescents (10-19 years) who are on ARV medication attending at care and treatment clinics, twelve parents/care takers of HIV positive adolescents and six health care providers providing HIV care and treatment services at the two selected high volume facilities in Dodoma Municipal. The sample size was 24 in-depth interview and one Focus Group Discussions (FGDs) with twelve members. Adherence level was measured using multi-method approach incorporating three different tool (self-reported, visual analogue scale and Pill identification tests).The setting was at the Care and Treatment Clinics during normal adolescent clinic days at Dodoma Regional hospital and Makole Urban health centre in Dodoma Municipal. Findings: The findings in this study suggests that very few adolescents (2/17) have high or good adherence level (above ninety five percent) to ARV medication while majority (15/17) present low level of adherence. Delayed disclosure of HIV status, unfriendly time (school hours and during examination) were among the individual factors found to be associated with poor adherence. Fear of parents to disclose to their children due to stigma, inadequate knowledge on psychosocial support and unfriendly environments including families and schools were among the social factors associated with poor/low adherence among ALHIV. Conclusion: Delayed disclosure has a big impact on ARV treatment adherence among HIV positive adolescents. Parents/care takers should be empowered to provide early disclosure to their HIV children to enable them cope with status. Family and communities should be supportive to ensure good adherence among ALHIV